1. Maxillofacial Prosthetics
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DR RITESH SHIWAKOTI
2013

2. History
 Artificial facial parts found on Egyptian
mummies long time ago.
 Ancient Chinese known to have made facial
restorations.
 1953 -- American Academy of Maxillofacial
Prosthetics founded.
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3. Overview
 Maxillofacial prosthetics is a branch
of prosthodontics in dentistry.
 Main aim is to restore the function
and esthetics of an individual.
 Its also approve a psychological
state of a patient after a trauma or
surgery.
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4. Maxillofacial Prosthetics
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 The art and science of anatomic,
functional, or cosmetic reconstruction by
means of nonliving substitutes of those
regions in the maxilla, mandible, and
face that are missing or defective
because of surgical intervention, trauma,
pathology, or developmental or
congenital malformations.

5. Type of M.F.P
Intra-Oral
Extra-Oral
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6. Indications of MFP
 After surgical intervention.
 After trauma.
 Congenital defects.
 Acquired defects.
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7. Prosthetic vs. Surgical Rehabilitation
 Individualized decision between
patient and doctor.
 Removable prosthesis allows for
cancer surveillance.
 Destruction amount.
 Malignancy recurrence.
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8. Intraoral vs. Extraoral
 Intraoral -- mostly functional
Mandible
Maxilla
 Extraoral -- cosmetic
Ear
Nose
Orbit
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9. Management of patient for MFP.
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 Personal history of a patient should be obtained.
 Dental and medical history also should be
obtained.
 Intra and external examination of a patient by a
maxillofacial surgeon and prosthodontics should
be done.

10. Management of patient for
MFP.
 Patients risk assessment should be
done.
 A surgeon should consulate with a
dentist about a surgery so that there
should be a team work.
 All surgical alterations should be
demonstrated for a dentist on a cast
and obturator should be made for a
day of a surgery.
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11. Psychosocial Issues 11

12. Dental Impression
 Surgeon has
marked
resection for
prosthodonti
c planning.
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13. Post surgical management.
 After a surgery and even before it’s a team work for a
rehabilitation of a patient that includes:
1. Maxillofacial surgeon.
2. Prosthodontics.
3. Orthodontist.
4. Phycastrist
5. Speech rehabilitation specialist.
6. Oncologist.
7. Plastic surgeon specialist
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14. Congenital defects
 Lip and palate development:
 Upper lip develop by coalescence of the
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premaxilla and maxillary growth centers on either
sides to produce the complete lip.
 Fusion of the of the lip developing from growth
centers commences around each nostril floor
and spreads downwards towards the lower
border of the lip uniting the premaxilla and
maxillary process in each side.

15. Congenital defects
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Failure of this union will result in a
cleft lip that varies from a notch on
one side to complete bilateral
cleft of the lip that may extend up
to into each nostril.

16. Congenital defects
 The palate:
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 Palate develops from the max. and premix.
growth centers, union of the three segments
commencing at the region of the nasal floor
presented in full development by the nasal
foramen.
 Union from this point proceeds backwards until
both the hard and soft palates and uvula have
united, and forwards along the of the future
maxillary and premaxillary structures eventually.

17. Congenital defects
• Lack of fusion of the palatal shelves either
completely or partially occurs during embryonic
growth side.
• Failure of union of palatine processes at any
stage will result in a cleft palate which may be
pre-alveolar ( cleft lip ) or post alveolar ( cleft
palate ) .
• Cleft palate between 6th – 9th wk. of the
embryonic life.
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18. Congenital defects
Classification of cleft palate
Pre-alveolar e.g. cleft lip
Post alveolar any cleft from uvula up
to incisive foramen.
Alveolar cleft extending from uvula
to alveolar ridge and lip either
unilateral or bilateral.
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19. Congenital defects
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 Effects of cleft palate and lip
1. Speech – lack of valvopharyngeal closure leads
to escape of air through the nose (nasal speech)
2. Deglutition – greatly impede the feeding,
regurgitation and escape of fluids through the
nose takes place .
3. Mastication – impaired due to escape of food
through the nasal cavity and due to missing
teeth and malocclusion .

20. Congenital defects
4. Esthetics – is effected seriously
especially in cleft palate and / or lip.
5. Deterioration of the general health
6. Psychological trauma .
7. Recurrent infection of the air ways
and middle ear .
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21. Congenital defects
 Management of cleft lip and palate Include the following:
A. Surgical closure
 It is the treatment of choice for palatal cleft closure. It
superior to prosthetic closure by obturator.
 If cleft involves the lip, it is advisable to repair it as early as
possible (6 wks. after birth) to facilitate feeding and
improve appearance.
 Surgical closure of palatal cleft is better to be done
before the end of the second year of age.
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22. Congenital defects
B. Prosthetic restoration
o Feeding appliances.
o Simple palatal plate to close cleft.
o Speech aid obturator.
o Over denture.
C. Orthodontic
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o To correct the malaligned teeth or expand the maxillary
arch.

23. Congenital defects
 Reason for early closure of cleft palate
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1. To produce longer and more mobile soft palate
with better muscular development and
2. velopharyngeal closure.
3. To habilitate the patient for normal speech.
4. To allow undisturbed growth of maxilla.

24. ACQUIRED PALATAL
DEFECTS
 DEFINITION:
 Lack of continuity of originally intact palatal
structures through the whole or part of its length.
 Etiology:
 Surgical e.g. tumor removal.
 Traumatic fracture of maxilla.
 Pathological conditions e.g. osteomyelitis, T. B.,
and syphilis .
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25. ACQUIRED PALATAL
DEFECTS
 Prosthetic rehabilitation of acquired maxillary defect:
 The main priority for the patient with traumatic injury and
traumatic surgery is to stabilize the patient and control
immediate damage and/or defect.
 Three phases of prosthodontic treatment includes:
 Surgical procedures + Immediate obturator.
 Transitional obturator.
 Definitive obturator.
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26. IMMEDIATE OBTURATOR
 IMMEDIATE OBTURATOR
1. It is a prosthesis inserted immediately after operation
2. Lasts 10-14 days after surgery
3. Material used, mostly acrylic
 ADVANTAGES:
1. Maintain function (feeding, speech)
2. Promote healing
3. Restore esthetic
4. Act as stint (keep surgical pack and medication close to the wound)
5. Improve psychology of the patient
6. Prevent contamination of the wound
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27. IMMEDIATE OBTURATOR
 Construction:
o Impression/construction of the cast models.
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o With the help of the surgeon determine the area to be
removed on the cast .
o The appliance is constructed as a plate to close the
operation site.
o Prepared cast is waxed, processed using either heat or
cold curing resin and wire clasps to retain the obturator.

28. IMMEDIATE OBTURATOR
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o During operation eradication of the
involved area, and surgical cavity is
filled with surgical pack.
o We can say, it is simple plate with no
teeth and constructed before surgery
to be inserted immediately after
surgery .

29. Temporary Obturators
Temporary/Transitional Obturator:
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Constructed few days after operation
to help in restoring oro-nasal function.
Carries teeth and stays 3-6 months.
Making impression is complicated by
presence of the wound and presence
of the defect.

30. Temporary Obturators
 The defect is packed with gauze
dipped in Vaseline to the level of
the remaining tissue, then
impression is taken with modified
stock tray using elastic impression
material.
 The steps of construction are the
same as in immediate obturator.
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31. Temporary Obturators
 Function: helps in restoring
1. Speech.
2. Feeding.
3. Esthetics.
4. Prevent wound contamination.
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32. Definitive Obturators
Definitive Obturator:
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It is a final prosthetic management
construction after complete
healing of the operation site .

33. Definitive Obturators
Preparation of the mouth
for obturator:
I. Extract hopeless teeth.
II. Periodontal therapy.
III. Restore carious teeth.
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34. Definitive Obturators
Types of obturators:
1. Hollow bulb (Closed).
2. Roofless (Open bulb).
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35. Definitive Obturators
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Construction:
1. Select stock tray, modified with wax
according to the size and shape of
the defect.
2. Partially, pack the defect with
Vaseline gauze, then do primary
impression using alginate.

36. Definitive Obturators
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3. Under cuts are lift to help in retention. Gauze
can prevent broken pieces of alginate from
escaping into the defect.
4. Construct sp. Trays and do final impression using
alginate or rubber base impression material.
5. Outline the master cast to mark the bearing
area, blocking severe undercut, leaving small
undercut area for obturator retention.

37. Premaxilla Preserved
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38. Premaxilla Preserved
 Cut through tooth socket
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39. Mucosa Not Preserved
 Rough edge uncomfortable for patient
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40. Obturator
Restores oro-nasal
partition.
At times can be
added to prior
dentures.
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41. Skin Grafting of Defect
Less pain while healing.
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Less contracture of scar band
which obscures cancer
surveillance.
Accomodates obturator better.

42. Maxillary Prosthesis
 Articulates with scar
band.
 Hollowed to be
lightweight.
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43. Maxillary Prosthesis
Can be made
with a reservoir
to hold artificial
saliva.
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44. Timing
Immediate (Intraoperative)
hold in packs
provide early function
Interim
Definitive
3 to 6 months
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45. Prosthetic Materials
Acrylics
Polyurethanes
Silicone Elastomers
Room-temperature
vulcanizing
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High-temperature vulcanizing

46. Mandible
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 Mandibular reconstruction
revolutionized by microvascular and
plating techniques.
 Prosthetics mainly restore occlusion and
occlusal surface.
 Implants able to restore high degree of
function.

47. Mandible
 Skin graft preserves alveolar ridge for denture support
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48. Postoperative Malocclusion
Deviates to surgical side
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49. Maxillary Ramp
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50. Maxillary Ramp
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51. Guide Plane Prosthesis
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52. Guide Plane Prosthesis
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53. Adjunctive Preprosthetic
Measures
Vestibuloplasty.
Lowering of Floor of Mouth.
Implants.
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54. Vestibuloplasty
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55. Lowering the Floor of
Mouth
 Goal is to reposition mylohyoid muscle.
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56. Lowering the Floor of
Mouth
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57. Edentulous Mandible 57

58. Mental Foramen
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59. Implants
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60. Implants
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Branemark in the 50’s studying
bone temp during drilling.
Found temp probes couldn’t be
removed from bone without
fracturing.
Led to study of osseointegration.

61. Implants
Made of titanium.
Have to be drilled at low speed.
Oxide on metallic surface is
dipole.
Plasma proteins adhere.
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62. Implants
Implant placed first -- closed primarily
Abutment placed 4-6 mo later
 Appliance attached
rigidly
removable
samarium-cobalt magnets
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63. Implants
Factors that influence success
material
macrostructure
microstructure
implant bed
surgical technique
loading conditions
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64. Implants
Implants can be placed in grafted
fibula.
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65. Implants
Want to avoid large step-off if
possible.
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66. Extraoral
Prostheses
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67. Extraoral Prostheses
General Principles:
 Goal is cosmetic.
 Retained with :
 Adhesives.
 Implants.
 Skin grafting may help.
 Smooth edges.
 Extraoral Prostheses Ear:
 Retain tragus if possible to camouflage anterior
border.
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68. Extraoral
Prostheses -- Ear
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69. Extraoral
Prostheses -- Ear
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70. Extraoral Prostheses -- Ear
Tragus hides attachment.
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71. 71
Extraoral Prostheses -- Orbit
Skin graft provides base for prosthesis.

72. Extraoral Prostheses -- Orbit
 Glasses help hide margin.
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73. Extraoral Prostheses -- Nose
 Skin graft provides base for prosthesis.
 Alar tag undesirable.
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74. Extraoral
Prostheses -- Nose
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75. Extraoral
Prostheses -- Nose
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76. Extraoral
Prostheses -- Nose
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77. Extraoral
Prostheses -- Nose
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78. Conclusion
Restore function and cosmesis.
Use techniques during surgery to
aid prosthetic management.
Consultation with maxillofacial
prosthodontist for optimal
rehabilitation.
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79. THANK YOU 79